Nonsteroidal anti-inflammatory drugs metabolism

SSRI = Selective serotonin reuptake inhibitor NSAID = Nonsteroidal anti-inflammatory drug CYP = cytochrome P-450 NAT2 = N-acetyl transferase type 2 J = Japanese C = Chinese A = African American. Poor metabolizers are not always at increased risk of ADR. 

Little information is available regarding tissue distribution or metabolic products of nonsteroidal anti-inflammatory drugs in cattle. The early synthetic compounds were simple derivatives either of salicylic acid such as acetylsalicylic acid and methylsalicylic acid, or of pyrazolone such as metamizole, oxyphenbuta-zone, phenylbutazone, propylphenazone, and suxibuzone. Modern nonsteroidal anti-inflammatory drugs are derivatives either of anthranilic acid such as dido-... 

The primary adverse effect of intravenous cidofovir is a dose-dependent nephrotoxicity. Concurrent administration of other potentially nephrotoxic agents (eg, amphotericin B, aminoglycosides, nonsteroidal anti-inflammatory drugs, pentamidine, foscarnet) should be avoided. Prior administration of foscarnet may increase the risk of nephrotoxicity. Other potential side effects include uveitis, decreased intraocular pressure, and probenecid-related hypersensitivity reactions. Neutropenia and metabolic acidosis are rare. The drug caused mammary adenocarcinomas in rats and is embryotoxic. 

Tarako et al. (1991) evaluated oxygen supply and energy state in the isolated perfused rat kidney. Metabolic activities of the isolated perfused rat kidney were described by Nishiitsutsuji-Uwo et al. (1967). Cox et al. (1990) used the isolated perfused rat kidney as a tool in the investigation of renal handling and effects of nonsteroidal anti-inflammatory drugs. 

For a displacement interaction to become clinically important, a second mechanism usually operates sodium valproate can cause phenytoin toxicity because it both displaces phenytoin from its binding site on plasma albumin and inhibits its metabolism. Similarly aspirin and probenecid (and possibly other nonsteroidal anti-inflammatory drugs) displace the folic acid antagonist methotrexate from its protein-binding site and reduce its rate of active secretion by the renal tubules the result is serious methotrexate toxicity. 

In two of the five spontaneous bleeding episodes described in Heading 4, medications that can affect platelet function or prothrombin time (PT) (i.e., aspirin and warfarin) were involved. Because GB is known to be an inhibitor of PAF (41), in theory GB could interact with antiplatelet drugs (e.g., aspirin, nonsteroidal anti-inflammatory drugs, clopidogrel, ticlopidine, dipyridamole) or anticoagulants (e.g., warfarin, heparin). EGb 761 was shown to potentiate the antiplatelet effect of ticlopidine in rats (42). However, in two studies in humans, the coadministration of GB with warfarin had no effect on either international normalized ratio or warfarin metabolism (43,44). 

Ibuprofen This is a commonly used nonsteroidal anti-inflammatory drug. Side effects and overdose can result in gastrointestinal bleeding or a metabolic acidosis. 

Furuta, S. Akagawa, N. Kamada, E. Hiyama, A. Kawabata, Y. Kowata, N. Inaba, A. Matthews, A. Hall, M. Kurimoto, T. Involvement of CYP2C9 and UGT2B7 in the metabolism of zaltoprofen, a nonsteroidal anti-inflammatory drug, and its lack of clinically signiflcant GYP inhibition potential, Br.J.Clin.PharmacoL, 2002, 64, 295-303. 

The balance between hydrophobicity and hydrophilicity likewise helps explain the differences between several well-known over-the-counter nonsteroidal anti-inflammatory drugs. For example, ibupro-fen, which is rapidly metabolized to relatively hydrophilic species, is fast acting, whereas naproxen is more lipophilic and thus has a slower onset but longer duration of action (see Figure 4.4 for structures). 

CYP2C9 is the major CYP2C enzyme expressed in human liver [35] and plays a major role in the metabolism of numerous therapeutics including many weak acidic drugs such as the nonsteroidal anti-inflammatory compounds (e.g. flurbiprofen) [36] and antidiabetics (e.g. tolbutamide) [37]. In addition, CYP2C9 also metabolizes (S)-warfarin [38], lornoxicam [39] and phenytoin [37]. 

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